In the midst of life…

Now what was I going to write about in this column? I can’t remember – perhaps I have incipient Alzheimer’s. That’s the clue. Alzheimer’s was just what I planned to write about. (Forgive the gallows humour but people of my age are all too familiar with the condition – too many of our friends have been affected. And its possibility looms ahead of us: will it be me? Will it be her? And when? So we make the occasional wry joke as if it were a charm to ward off the phantom.)

Dementia of different types affects well over half a million people in England. Sixty per cent of these have Alzheimer’s. It is estimated that one in 14 people over the age of 65, and one in six over 80, have the condition. The incidence of Alzheimer’s worldwide is expected to quadruple by 2050.

The disease was first demonstrated in 1906 by Alois Alzheimer who described the brain changes, discovered post mortem, in a 55-year-old patient. Since then an enormous amount of work has been devoted to studying the disease, although at present we can do no more than delay its onset to a degree. Our strides in knowledge of genetics and methods of surveying the action of the brain put us in a better position nowadays to discover effective therapies to alleviate or cure the problem. But don’t hold your breath.

At a macro level, Alzheimer’s causes growing atrophy of the brain, and the hallmarks are described as amyloid proteins plaques and tau proteins causing tangles (together with a number of other “biomarkers”). The technical details are perhaps of less importance than our current recognition that the processes leading to severe symptoms may start 10 or more years beforehand. New clinical guidelines for the disease itself have recently been published by The Journal of the Alzheimer’s Association. Three approximate stages are described: preclinical, mild cognitive impairment and Alzheimer’s dementia (more details here, if you can bear them).

At the pre-clinical stage the brain changes may already have started although significant symptoms are not apparent. In some instances special tests can demonstrate changes but, as yet, the likelihood of progression to full Alzheimer’s for such people is not yet known. A great deal more work must be done to establish and standardise such markers, and the studies can only be for research for the time being. There are, of course, ethical problems in diagnosing a future condition where no reliable way of averting it has been established.

Mild cognitive impairment means roughly what it describes. The changes in performance and biomarkers can more easily be identified although they do not tell clinicians for certain whether Alzheimer’s will result. Again, the studies here are mainly to be used as a framework for research.

Alzheimer’s dementia is the final stage. Investigations go beyond memory loss, and look at other forms of cognitive impairment. Alzheimer’s must, as accurately as possible, be distinguished from other forms of dementia. The disease follows a typical course of gradual impairment which may start at a level which is only externally obvious to close relatives and progresses until the sufferer is totally dependent on nursing care. The whole dementia phase lasts from seven to 10 years, and results in death.

The bad news is that the long build up to the beginning of dementia proper means that many of us reading this are, unbeknown to us, already on the path. That certainly includes me in my eighth decade. The good news is that our techniques for brain diagnosis and our understanding of genes have made great advances, and it is a reasonable hope that we will eventually develop cures and alleviations which can be employed while, or before, the disease is in its preparatory phase. You may get an idea of the activity on the Alzheimer front from the fact that in 2011 my files show that I have noted one new study of significance published for every week of the year.

Almost at random I give you some examples. Clinical trials of a vaccine which may halt or even reverse amyloid plaque build-up (Southampton University). A new approach to analysing brain signals which may give early warning of the approach of the disease (University of Strathclyde). New refinements in MRI scanning may enable early detection (Radiology). Discovery of several new genes which may help to establish Alzheimer risk, and provide the basis of a cure (Cardiff University and Mount Sinai School of Medicine). Progress made in attempts to recover damaged neurons through use of Stem Cells (Stem Cells). Value of increased social activity in warding off cognitive decline (Rush University). A “state-of-the-art” review, invaluable for this column, (Hozman, Morris, and Goate, April 2011). Even as I write I see another Alzheimer story looming on my electronic horizon – but I have to stop somewhere.

We have to approach philosophically the likelihood that, while the scientists are hacking their way through the undergrowth, few of us reading this will benefit ourselves. After all, I avoided my grandfather’s death through a heart attack by having bypass surgery not available in his time. She who would have been my mother-in-law died from TB during World War II; a few years later and she would have survived. Cancer is far from beaten but there are many cures developed recently. So the work that is done today – either by scientists or by those who support them – is our way of repaying the extra years which previous generations have gained for us.

About Quentin

Portrait © Jacqueline Alma
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16 Responses to In the midst of life…

  1. Ion Zone says:

    According to the scientific press, having the genes for Autism almost eliminates your chances of developing Alzheimer’s. I couldn’t tell you if this is true or not, but I hope so, slowly forgetting who you are because of plaque on your brain is a horrible way to go.

  2. John Candido says:

    All progressive degenerative brain disorders (PDBD) for example Alzheimer’s, Dementia, Parkinson’s etc. fill us all with dreadful fear, not only for ourselves but for everybody who we know. We have got to pray that our scientists get to the end of this scourge, preferably with cures or with very effective treatments. The cost to our economy of looking after people afflicted with any PDBD is another reason we have got to pray for and support all of our scientists who do this very important work.

  3. Horace says:

    Until a few years ago Alzheimer’s disease was known as “pre-senile dementia”.
    Dementia in older people (I am a little older than Quentin) was considered essentially ‘normal’ and an expected concomitant of ageing.
    Remember :- Ecclesiasticus 3/14,15
    “Son, support the old age of thy father, and grieve him not in his life;And if his understanding fail, have patience with him, and despise him not when thou art in thy strength: for the relieving of the father shall not be forgotten.”

    Nowadays it is well recognised that the commonest cause of dementia in older people is Alzheimer’s. There may be abnormal changes in the brain of the type seen in this disease ten or more years before symptoms develop and indeed symptoms may never develop during life.
    Many other causes of ‘senile dementia’ are recognised today, of which the commonest is probably vascular dementia (related, inter alia, to high blood pressure, heart problems, high cholesterol and diabetes). Dementia is also found in association with other diseases of which perhaps the best known are Creutzfeldt-Jakob disease (aka ‘mad cow disease’), Parkinson’s and Huntington’s.

    My own interest has always been in the electrical activity of the brain (rather than anatomy, biochemistry or genetics) and I am impressed by the little known studies carried out by Thomas Koenig in Switzerland which show that the development of dementia (and surprisingly also schizophrenia) can be followed over time by recording from many regions of the brain and estimating Global Field Synchronization (the degree with which activity all over the brain is correlated so that the brain acts as a coherent whole).

    Eventually, of course, the brain becomes so disorganised that consciousness is lost and with death brain activity ceases altogether.

    There is a good deal of theological argument concerning the precise relationship between brain activity and death and anyone interested might like to read the book “Finis Vitae” obtainable from Fondazione Lepanto .

  4. Quentin says:

    Horace, thank you for this additional information. I was hoping you would have time to contribute.

  5. Trident says:

    I was interested in the question about how we feel about death. In theory I suppose that we ought to look forward to it. After all it’s the end of our time of trial and, although we’ll probably have a spell in purgatory. we’re on our way.
    But I am in two minds. If you asked me if I believed in life after death I would immediately and quite sincerely say, yes. But when I am on my own I find that I am not so sure. Does anyone else feel that?

  6. Iona says:

    It’s not so much that I feel unsure about “life after death”. It’s rather that the imagination is utterly baffled at what it is going to be like. And that in itself is decidedly alarming.

  7. Iona says:

    And as regards Alzheimer’s, I remind myself of the “act of resignation”: “Oh Lord, my God, whatever manner of death is pleasing to you, with all its anguish, pains and sorrows, I now accept from your hand with a resigned and willing spirit”. (Not that I am claiming to feel particularly resigned, let alone willing).

  8. st.joseph says:

    Eyes hath not seen nor ears hath not heard the wonders God has prepared for those that love Him.
    I think we all wonder at times what the resurrection of the body for us means.
    Jesus speaks about this in (St Luke.chpt 20; v 27-40.) and (St Mark.chpt 12;v18.27)
    The Transfiguration can also be an insight into the Mystical, whereby once experiencing -it one would never want to leave. Like the apostles said to Jesus ‘Let us make a tent ‘etc;
    I have thought about it more since my husband died -the two ref; above particularly.
    the women with the seven husbands,which husband will she be with in the end.
    If one contemplates on St Luke or St Mark, and the Transfiguration-a better understanding may become clear, but never as clear as the real thing! As the Psalm of David says- Desire for God No 63. and Psalm No.84. Pilgrimage song’ and No 3 The Song of Songs.
    Something like Quentin’s last post, ‘Seeing dimly through a mirror’.
    I find the Psalms very inspiring!

  9. Superview says:

    Trident’s contribution is helpful and honest. My present thoughts are full of questions about the conventional Christian opinion on life after death, but against a default position that still leaves me with the chance of opting in (or so I think). I do like Socrates reflection – ‘Why should I fear death? It is either the oblivion of a dreamless sleep or eternity with the Gods.’
    The doctrines about life after death that are presented to us – the resurrection of the dead, the Judgement, and heaven and hell, are so replete with metaphor and resistant to enquiry that they fail to satisfy the simplest questions. We had a sermon a few months ago that dwelt on the fact that, although we will be eaten by worms and disappear into the earth, God being God, will be able to reconstitute our bodies at the resurrection of the dead. I’m sure that God as God would be able to do that, but I can’t get out of my head lots of little queries (age, length of hair, dental work); but, actually, given that our souls are spirit and we are destined for the spirit world, the bigger question is why would God bother?
    So what happens after the Judgement? If the great medieval artists are right (following the Gospels of course) some of us, with our restored bodies, will float up to heaven in the clouds and others be cast down naked into hell. Well, I agree it is difficult to represent a spirit in contrast to a body, but we clearly have a problem with what happens to the resurrected body.
    I have somewhere another CTS pamphlet that tells the story of the war between God and His angels and Lucifer and his gang, and how they were cast down to earth. It strikes me as entirely fanciful. It also poses another modern tension between faith and science, given what we know about the evolution of our planet.
    And what about hell? Another little treasure found in my loft is a publication of the Irish CTS, dated 19 March 1946, luridly illustrated with flames filling half the cover, and entitled in capitals ‘HELL AND ITS PUNISHMENTS’. It develops a closely argued Scriptural case for hell, with Matthew’s and Mark’s gospels especially favoured (and with an insistence that it will be an actual fire – although it is a fire that ‘acts on spirit – on the demons and the souls of the reprobate now separated from their bodies’). The author, one Rev. T. Roche, CSSR, is hot on the fire, so to speak: ‘if a Catholic refused to admit the reality of the fire of hell …. he would certainly be guilty of grave sin against the Faith.’ So that’s hell sorted then.
    I can see the problem. If it’s in Scripture then it must be true. Yet we know that’s not quite all of it?

  10. Horace says:

    To me the great mystery of death is that of eternity. Eternity, by definition, is outside of time – not just a very very long time but outside of time.
    “. . before Abraham was. I am”
    This is a scientifically reputable concept (time can be considered a dimension) but I cannot imagine consciousness, much less free will, outside of time – “eye hath not seen nor ear heard . . ?” .
    Why the resurrected body? This, I think, simply emphasises that the human person is not only spirit but soul and body. Quite how we can imagine ‘body’ outside of time I do not know, but the story of Christ’s resurrected body may give us some clues.
    Finally, to quote Shakespeare “. . for in that sleep of death what dreams may come . .”. If we can imagine consciousness outside of time then we can imagine peace and happiness; agony and despair.
    Perhaps this is the whole point of TIME – an environment in which we can choose.

  11. st.joseph says:

    I have often wondered about out of body experiences. People have felt this after death and came back.When they say they were following strong light.
    When my husband died, a wonderful smile came over his face.It sticks in my mind.
    A few nights after he died, I experienced a heat which woke me up, and I saw his face, then it vanished.
    I was probably in a state of distress, but neverthless, it is imprinted on my mind and the heat. I put it down to a little assurance from him, I don t know what else to think about it.Has anyone else experienced it?

    • st.joseph says:

      I also think a that when we receive the Gifts of the Holy Spirit on our souls-that is where our enlightenment comes from-particularly our Gift of Understanding. We see with our Soul.
      The Catechism tells us that we are made in the image and likeness of God in our soul.And we know that Jesus is made in the image and likeness of us in our bodies-but without sin.So we have to try and bring our nature like His Divine nature in our Soul.
      Like what Horace says is quite right.
      Our earthly body dies at death-but our souls live on and I believe that however enlightened we are- we can see with the eyes of our souls when we die.
      A priest told my husband many many years ago when he was having difficulty with the Real Presence, that if God was to reveal Himself in one go our minds would explode.He will only reveal to us what He thinks we can understand.
      Maybe the journey of our soul into New Life from our Baptism is one long journey and continues after death-our soul lives on and that is what we see with as much as we have understood.
      My mother used to tell us when we were little that when we do a little sin, it makes a black spot on our soul, it is wiped off when we are sorry,and when we die hopefully it will be all white ones. I felt it was an easy thought when young, so I would say sorry Jesus,and hope the spot would go. (When I kicked my brothers or took all the tyres off their cars etc)

      • st.joseph says:

        Then my mother told me I had to atone for my sins. and I had to put the tyres back on again.

  12. st.joseph says:

    So then I thought what about my brothers, when I kicked them.
    So how do I atone for that. I would say sorry, and hope they would forgive me.
    As my mother said, ‘yes they would have to forgive you’,because if they didn’t, God wouldn’t forgive them either.
    Simple lessons learned as children and it is all true. I remember these things as a child,and passed them on to my children, and they passed them on to their children.
    With the Lord in mind. As I was always told by my mother that He came first.

  13. mike Horsnall says:

    Personally thinking I find it screamingly obvious that we have a place in eternity-I see it as a distant landscape beckoning and welcome. I never had this sense until I was converted some 25 years ago but now it grows steadily and most welcome-the sense that one could step off ones doorstep and walk into a welcoming, recognisable and recognising, heaven. I do not know why I am like this-so centred on the sublime I mean-I am also aware that when sin clouds my eye I am plunged into a kind of darkness and inner despair…this is the motor for fairly regular confession I might add -as opposed to law.

    Why all this detail? Because I think it important for the understanding that we recognise how different we are and that what lies underneath much of our differing interpretations over issues is our specific temperament and our uniqueness. For me I only have to look out of the window to ‘see’ heaven and sense the proximity of God. I do not know what this means for I certainly am no saint nor ever have been. But this sense does make me well suited for taking communion round hospitals and to the dying etc because I can rest in what I ‘know’ to be true and not cloud the dying of others with my personal insecurity. So I am grateful for this particular sensitivity although its corollary is very occasional but severe bouts of depression. Many of our writers about God in history were I think of a similar disposition-some were not and hewed their likeness from doughty reason alone.

    The only sense I can make of bodily ressurection is the continuing conviction that bodies do not have to be made of human flesh to exist-presumably angels have bodies and Jesus’ body did some quite remarkable things.

    So I am not much help regarding certainty except to note that I do believe it to be true that -rather as the more we walk in mountains the more we love them- then likewise searching after God is more liable to bring us to his foothills than if we remain content with the far off view. The more I give myself to God over the years the more I seem to see God all around me and the closer heaven seems.

    • Superview says:

      Thank you Mike Horsnall. I appreciate the expression of your personal insights. Beautifully written and as you say in parts sublime.

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